Skip to main content
SpringerLink
Log in

Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction

  • ORIGINAL ARTICLE
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Recent evidence suggests that postischemic myocardial dysfunction (“stunning”) may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia–reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. JI Goldhaber JN Weiss (1992) ArticleTitleOxygen free radicals and cardiac reperfusion abnormalities Hypertension 20 118–127 Occurrence Handle1:CAS:528:DyaK38XkvVOksrk%3D Occurrence Handle1618547

    CAS  PubMed  Google Scholar 

  2. ED Grech NJ Dodd MJ Jackson WL Morrison EB Faragher DR Ramsdale (1996) ArticleTitleEvidence for free radical generation after primary percutaneous transluminal coronary angioplasty recanalization in acute myocardial infarction Am J Cardiol 77 122–127 Occurrence Handle10.1016/S0002-9149(96)90580-9 Occurrence Handle1:STN:280:DyaK287ktlahtQ%3D%3D Occurrence Handle8546077

    Article  CAS  PubMed  Google Scholar 

  3. DD Buechter (1998) ArticleTitleFree radicals and oxygen toxicity Pharm Res 5 253–260 Occurrence Handle10.1023/A:1015914418014

    Article  Google Scholar 

  4. R Bolli BS Patel MO Jeroudi EK Lai PB McCay (1988) ArticleTitleDemonstration of free radical generation in “stunned” myocardium of intact dogs with the use of the spin trap alpha-phenyl N-tert-butyl nitrone J Clin Invest 82 476–485 Occurrence Handle1:CAS:528:DyaL1cXlsVGlsb0%3D Occurrence Handle2841353 Occurrence Handle10.1172/JCI113621

    Article  CAS  PubMed  Google Scholar 

  5. R Bolli (1990) ArticleTitleMechanism of myocardial “stunning Circulation 82 723–738 Occurrence Handle1:STN:280:DyaK3czmslalug%3D%3D Occurrence Handle2203553

    CAS  PubMed  Google Scholar 

  6. S Suzuki M Kaneko DC Chapman NS Dhalla (1997) ArticleTitleAlterations in cardiac contractile proteins due to oxygen free radicals Biochim Biophys Acta 1074 95–100

    Google Scholar 

  7. NS Dhalla L Golfman S Takeda N Takeda M Nagano (1999) ArticleTitleEvidence for the role of oxidative stress in acute ischemic heart disease: a brief review Can J Cardiol 15 587–593 Occurrence Handle1:CAS:528:DyaK1MXjvFKqsrs%3D Occurrence Handle10350670

    CAS  PubMed  Google Scholar 

  8. P Liu CE Hock R Nagele PY Wong (1997) ArticleTitleFormation of nitric oxide, superoxide, and peroxynitrite in myocardial ischemia-reperfusion injury in rats Am J Physiol 272 H2327–H2336 Occurrence Handle1:CAS:528:DyaK2sXjsFWlsL4%3D Occurrence Handle9176302

    CAS  PubMed  Google Scholar 

  9. A Singh KJ Lee CY Lee RD Goldfarb MF Tsan (1989) ArticleTitleRelation between myocardial glutathione content and extent of ischemia-reperfusion injury Circulation 80 1795–1804 Occurrence Handle1:CAS:528:DyaK3cXps1emsg%3D%3D Occurrence Handle2598438

    CAS  PubMed  Google Scholar 

  10. N Haramaki DB Stewart S Aggarwal H Ikeda AZ Reznick L Packer (1998) ArticleTitleNetworking antioxidants in the isolated rat heart are selectively depleted by ischemia-reperfusion Free Radic Biol Med 25 329–339 Occurrence Handle10.1016/S0891-5849(98)00066-5 Occurrence Handle1:CAS:528:DyaK1cXks1ChtbY%3D Occurrence Handle9680179

    Article  CAS  PubMed  Google Scholar 

  11. R Bolli MO Jeroudi BS Patel OI Aruoma B Halliwell EK Lai PB McCay (1989) ArticleTitleMarked reduction of free radical generation and contractile dysfunction by antioxidant therapy begun at the time of reperfusion. Evidence that myocardial “stunning” is a manifestation of reperfusion injury Circ Res 65 607–622 Occurrence Handle1:CAS:528:DyaL1MXls1OjsL8%3D Occurrence Handle2548761

    CAS  PubMed  Google Scholar 

  12. R Sethi N Takeda M Nagan NS Dhalla (2000) ArticleTitleBeneficial effects of vitamin E treatment in acute myocardial infarction J Cardiovasc Pharmacol Ther 5 51–58 Occurrence Handle1:CAS:528:DC%2BD3cXhtlais7s%3D Occurrence Handle10687674

    CAS  PubMed  Google Scholar 

  13. R Ferrari C Ceconi S Curello A Cargnoni O Alfieri A Pardini P Marzollo O Visioli (1991) ArticleTitleOxygen free radicals and myocardial damage: protective role of thiol-containing agents Am J Med 91 IssueIDsuppl 3C 95S–105S Occurrence Handle1:CAS:528:DyaK38XltVKgsQ%3D%3D Occurrence Handle1928219 Occurrence Handle10.1016/0002-9343(91)90291-5

    Article  CAS  PubMed  Google Scholar 

  14. J Sochman J Kolc M Vrana J Fabian (1990) ArticleTitleCardioprotective effects of N-acetylcysteine: the reduction in the extent of infarction and occurrence of reperfusion arrhythmias in the dog Int J Cardiol 28 191–196 Occurrence Handle10.1016/0167-5273(90)90060-I Occurrence Handle1:STN:280:DyaK3czmvVamsQ%3D%3D Occurrence Handle2394523

    Article  CAS  PubMed  Google Scholar 

  15. MB Forman DW Puett CU Cates DE McCroskey JK Beckman HL Greene R Virmani (1988) ArticleTitleGlutathione redox pathway and reperfusion injury. Effect of N-acetylcysteine on infarct size and ventricular function Circulation 78 202–213 Occurrence Handle1:CAS:528:DyaL1cXkvVKjtr8%3D Occurrence Handle3383404

    CAS  PubMed  Google Scholar 

  16. IS Young ER Trimble (1991) ArticleTitleMeasurement of malondialdeyhde in plasma by high performance liquid choromatography with fluorimetric detection Ann Clin Biochem 28 504–508 Occurrence Handle1958055

    PubMed  Google Scholar 

  17. InstitutionalAuthorNameAmerican Society of Echocadiography Committee on Standards (1989) ArticleTitleRecommendations for quantitation of the left ventricle by two dimensional echocardiography J Am Soc Echocardiogr 2 358–367

    Google Scholar 

  18. F Nielsen BB Mikkelsen JB Nielsen HR Andersen P Grandjean (1997) ArticleTitlePlasma malondialdehyde as biomarker for oxidative stress: reference interval and effects of life-style factors Clin Chem 43 1209–1214 Occurrence Handle1:CAS:528:DyaK2sXktlClsrg%3D Occurrence Handle9216458

    CAS  PubMed  Google Scholar 

  19. B Giardino M Penco G Lazzarino S Romano B Tavazzi F Fedele D Di Perro A Dagianti (1993) ArticleTitleEffectiveness of thrombolysis is associated with a time dependent increase of malondialdehyde in peripheral blood of patients with acute myocardial infarction Am J Cardiol 71 788–793 Occurrence Handle10.1016/0002-9149(93)90825-W

    Article  Google Scholar 

  20. Y Tripathi BM Hegde (1998) ArticleTitleEffect of N-acetylcysteine on myocardial infarct size following ischemia and reperfusion in dogs Indian J Physiol Pharmacol 42 50–56 Occurrence Handle1:CAS:528:DyaK1cXhsVyiu7w%3D Occurrence Handle9513793

    CAS  PubMed  Google Scholar 

  21. MA Arstall J Yang I Stafford WH Betts JD Horowitz (1995) ArticleTitleN-Acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction safety and biochemical effects Circulation 92 2855–2862 Occurrence Handle1:CAS:528:DyaK28XitlSmtw%3D%3D Occurrence Handle7586252

    CAS  PubMed  Google Scholar 

  22. J Sochman J Vrbska B Musilova M Rocek (1996) ArticleTitleInfarct size limitation: acute N-acetylcysteine defense (ISLAND trial: preliminary analysis and report after the first 30 patients) Clin Cardiol 19 94–100 Occurrence Handle1:STN:280:DyaK28vhvVKgsA%3D%3D Occurrence Handle8821417 Occurrence Handle10.1002/clc.4960190205

    Article  CAS  PubMed  Google Scholar 

  23. S Boesgaard HK Iversen H Wroblewski HE Poulsen H Frandsen J Kastrup J Aldershvile (1994) ArticleTitleAltered peripheral vasodilator profile of nitroglycerin during long-term infusion of N-acetylcysteine J Am Coll Cardiol 23 163–169 Occurrence Handle1:CAS:528:DyaK2cXlslSitro%3D Occurrence Handle8277075 Occurrence Handle10.1016/0735-1097(94)90515-0

    Article  CAS  PubMed  Google Scholar 

  24. JD Horowitz CA Henry ML Syrjanen WJ Louis RD Fish TW Smith EM Antman (1988) ArticleTitleCombined use of nitroglycerin and N-acetylcysteine in the management of unstable angina pectoris Circulation 77 787–794 Occurrence Handle1:STN:280:DyaL1c7msFCguw%3D%3D Occurrence Handle3127076

    CAS  PubMed  Google Scholar 

  25. R Atak M Ileri K Senen H Turhan AR Erbay N Basar E Yetkin D Demirkan (2004) ArticleTitleCorrelation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy Heart Vessels 19 63–67 Occurrence Handle10.1007/s00380-003-0740-x Occurrence Handle15042389

    Article  PubMed  Google Scholar 

  26. P Buszman A Szafranek Z Kalarus M Gasior (1995) ArticleTitleUse of changes in ST segment elevation for prediction of infarct artery recanalization in acute myocardial infarction Eur Heart J 16 1207–1214 Occurrence Handle1:STN:280:DyaK287ksFyhuw%3D%3D Occurrence Handle8582383

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, Uludag University Medical School, Kardiyoloji Anabilim Dali, Gorukle, Bursa, 16059, Turkey

    Dilek Yesilbursa, Akin Serdar, Tunay Senturk, Saim Sağ & Jale Cordan

  2. Biochemistry Department, Uludag University Medical School, Bursa, Turkey

    Zehra Serdar

Authors
  1. Dilek Yesilbursa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akin Serdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tunay Senturk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zehra Serdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saim Sağ
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jale Cordan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dilek Yesilbursa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yesilbursa, D., Serdar, A., Senturk, T. et al. Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction. Heart Vessels 21, 33–37 (2006). https://doi.org/10.1007/s00380-005-0854-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-005-0854-4

Key words

Search

Navigation